Provider Demographics
NPI:1285846493
Name:BLUE RIDGE EAR, NOSE AND THROAT, INC.
Entity Type:Organization
Organization Name:BLUE RIDGE EAR, NOSE AND THROAT, INC.
Other - Org Name:CHARLES W. FORD, M.D., P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:FORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:828-264-4545
Mailing Address - Street 1:870 STATE FARM RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4861
Mailing Address - Country:US
Mailing Address - Phone:828-264-4545
Mailing Address - Fax:828-264-3279
Practice Address - Street 1:870 STATE FARM RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4861
Practice Address - Country:US
Practice Address - Phone:828-264-4545
Practice Address - Fax:828-264-3279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC009400056207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8932979Medicaid
NCF73369Medicare UPIN
NC2325244Medicare ID - Type Unspecified